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目的 探讨老年高血压病患者静息心率 (restingheartrate ,RHR)与靶器官损害的关系。方法 入选老年高血压病患者 2 0 6例 ,按收缩压 (SBP)水平分为三组 :SBP <16 0mmHg(1mmHg =0 133kPa) ,16 0mmHg≤SBP <180mmHg ,SBP≥ 180mmHg。在以上每一组中 ,又按RHR水平分为 :RHR1组 ,<6 5次 /min ;RHR2组 ,6 5次 /min≤RHR <6 9次 /min ;RHR3组 ,70次 /min≤RHR <74次 /min ;RHR4组 :75次 /min≤RHR <79次 /min ;RHR5组 ,RHR≥ 80次 /min。对入选患者做以下检查 :心电图、超声心动图、颈动脉超声、肌酐清除率以及尿微量白蛋白。结果 (1)RHR5组的尿微量白蛋白定量和左心室质量指数均高于RHR1～RHR4各组 (P <0 0 5或P <0 0 1)。RHR5组或RHR4组的颈动脉内膜厚度和颈动脉内径大于RHR1和RHR2组 ;而左室射血分数和肌酐清除率小于RHR1和RHR2组 (P <0 0 5或P <0 0 1)。(2 )RHR与颈动脉内膜厚度、颈动脉内径、左心室质量指数、尿微量白蛋白定量呈正相关 (r分别为 0 312、0 2 89、0 6 30、0 5 76 P <0 .0 1) ,而与左室射血分数、肌酐清除率呈负相关 (r分别为 - 0 5 6 3、- 0 5 10 ,P <0 .0 1)。结论 RHR的增加是老年高血压病患者靶器官损害的重要危险因素。
Objective To investigate the relationship between resting heart rate (RHR) and target organ damage in elderly patients with essential hypertension. Methods Twenty-six elderly patients with hypertension were divided into three groups according to systolic blood pressure (SBP): SBP <160 mmHg (1 mmHg = 0 133 kPa), 160 mmHg≤SBP <180 mmHg and SBP≥ 180 mmHg. In each of the above groups, RHR1 group, <6 5 times / min, RHR2 group, 6 5 times / min≤RHR <6 9 times / min, RHR3 group, 70 times / min≤RHR <74 times / min; RHR4 group: 75 times / min≤RHR <79 times / min; RHR5 group, RHR≥80 beats / min. The following patients were examined: electrocardiogram, echocardiography, carotid ultrasound, creatinine clearance, and urinary microalbumin. Results (1) Urinary microalbuminuria and left ventricular mass index in RHR5 group were higher than those in RHR1 ~ RHR4 group (P <0.05 or P <0.01). The carotid intima-media thickness and carotid artery internal diameter in RHR5 group or RHR4 group were greater than those in RHR1 and RHR2 group, while the left ventricular ejection fraction and creatinine clearance rate were lower than those in RHR1 and RHR2 group (P <0.05 or P <0.01). (2) There was a positive correlation between RHR and carotid intima-media thickness, carotid artery diameter, left ventricular mass index and urinary microalbumin (r = 0 312,0 2 89,0 6 30,0 5 76 P <0 0 1), but negatively correlated with left ventricular ejection fraction and creatinine clearance (r = -0.563, -0.05, respectively, P <0.01). Conclusion The increase of RHR is an important risk factor of target organ damage in elderly patients with hypertension.